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3 Progress towards a new model of emergency care delivery in Denmark Specific plans from all Regions describing implementation of recommendations from Sundhedsstyrelsen Fagomraadsbeskrivelsen for akutmedicin by DMS – education based on this has started Many FAME enheder established at regional hospitals Agreements with primary sector and psychiatry for cooperation with FAME enheder New national model for klinisk basisuddannelse – all nye læger spend some time in FAM

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10 Potential limitations for use in measuring emergency care quality? Early stages of development? –Much EM specific content yet to be developed –How long will it take to develop? When is a quality measurement tool needed? Too general? –Do they contain the necessary detail to provide useful guidance for development of emergency care system? Political dimensions? –Committee-driven process w/ many stakeholders, many agendas –Tend towards least controversial standards, maintain status quo –Will they produce standards that push a necessary paradigm shift?

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20 What system perspectives would you prioritize? ? ? ? ? Which indicators would you choose?

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21 System Elements Related to Quality “the resources we use, and conditions under which, we deliver care” “what happens to patients as a result of our delivering care to them” “what we do to patients in the process of delivering care StructureProcessOutcome Donabedian, JAMA, 1988 “Good structures increase the likelihood of good processes, and good processes increase the likelihood of good outcomes.”

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29 Process Indicators of Emergency Care Quality StructureProcessOutcome What did we do to the patient? How well was it done? Process measures ideally need compelling evidence linking them to desired outcomes to be valid When hard evidence doesn’t exist, process measures can be based on expert consensus Representative tasks performed in the FAM –Diagnostics –Therapeutics –Others Representative conditions seen in the FAM –Common problems –Across spectrum of acuity

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36 Outcome Indicators of Emergency Care Quality StructureProcessOutcome What happened to the patient as a result of the care that was provided? To what extent can we expect changes in FAM care delivery to change the outcome? Need for risk adjustment of outcomes? Health Status –Morbidity –Mortality (???) –Disability Patient Satisfaction –Overall Impressions –Communication –Consideration –Responsiveness

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39 Outcome Indicators of Emergency Care Quality Examples of Patient Satisfaction Indicators: Overall Impressions –Patients’ assessments, overall, of their ED stay Communication –Patients’ assessments of how well information was communicated to them or their family during their ED stay Consideration –Patients’ assessments of whether they were treated with respect and courtesy by doctors, nurses and staff during their stays in the ED Responsiveness –Patients’ assessments of the amount of time they waited to see doctors and nurses and receive test results, assessments of pain management; assessments of team work; and staff’s responsiveness to their needs StructureProcessOutcome Hospital Report 2007: Emergency Department Care. Ontario Hospital Assoc.

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40 Putting it all together Excellent foundation with existing quality frameworks, metrics, data gathering –Danske Kvalitetsmodel (DKM), National Indikator Project (NIP) –Patients Administrative Systemer (PAS) –Landspatientregistret (LPR) Simplified overview of key perspectives, indicators to drive uniform development –Balanced scorecard Additional indicators to create a meaningful framework of measures: –Wide range of examples from international experience –Structural conditions that support development of effective FAM system –Focus on patients, processes seen in the FAM